Provider Demographics
NPI:1578317319
Name:AMBRIDGE CHIRO LLC
Entity Type:Organization
Organization Name:AMBRIDGE CHIRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-513-5807
Mailing Address - Street 1:1405 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-2257
Mailing Address - Country:US
Mailing Address - Phone:724-266-2155
Mailing Address - Fax:
Practice Address - Street 1:1405 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-2257
Practice Address - Country:US
Practice Address - Phone:724-266-2155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty